AB1074 TO ASSESS ADHERENCE TO OMERACT/ASAS RECOMMENDATION FOR MRI PROTOCOL IN AXIAL SPONDYLOARTHRITIS
Authors: D. Hassan, M. Shahzad, A. Jilani
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The interpretation of MRI in Axial Spondyloarthritis (AxSpA) has been a topic of much debate and controversy. The OMERACT/ASAS MRI group devised a list of recommendations for the protocol used in diagnostic MRI for AxSpA [1]. MRI of the sacroiliac joints (SIJs) is of crucial importance in confirming a diagnosis of AxSpA in patient presenting with back pain and a positive interpretation has a major impact on early diagnosis. The lack of agreement on a positive MRI and limited expertise in interpreting these MRI images [2] is the main stumbling block in the long diagnostic delay still seen in patient with AxSpA [3]. <h3>Objectives</h3> We carried out a retrospective survey to assess the protocol being used in the Radiology department for requests for diagnostic MRI of spine and SIJs in patient presenting with features of inflammatory back pain. The recommended protocol is to perform short T1 inversion recovery (STIR)and T1 weighted sequences of the whole spine in sagittal view and coronal oblique views of the SIJs. <h3>Methods</h3> Data was collected retrospectively on 57 patients confirmed to have a diagnosis of AxSpA made by a rheumatologist, from 2015 to 2022. The protocol used for the MRi imaging was confirmed from the available radiological reports and where required further clarification of the protocol used was confirmed by the help of the performing and reporting radiologist. We also made note of the HLA-B27 status of this cohort and the use of NSAIDS and c DMARD and subsequent use of biological agents. <h3>Results</h3> Of the 57 patients included in this study, 25 were female and 32 were male. Just over one third of the patients (n= 23) were HLA-B27 positive, with under a third were HLA-B27 negative (n= 20), and in about a quarter of the cohort this had either not been checked or was not documented. In this cohort 16 patients were diagnosed within two years of onset of symptoms and about a third (n=23) within 5 years of onset of first symptoms. The duration of first onset of symptoms to diagnosis ranged from 7 months to a maximum of 10 years, giving a mean value of just over 7 years. Out of the 57 patients studied, about a third (n=26) had their first MRI according to the SpA protocol. A subsequent MRI was carried out in 19 patients and 11 of these were according to the SpA protocol. <h3>Conclusion</h3> The correct SpA protocol is still not being applied to all inflammatory back pain imaging requests. In this study we note that although this has improved in subsequent imaging, the fact remains, that not all Radiologists are fully compliant with the use of the correct SpA protocol. This is adding to the diagnostic delay and hence commencement of appropriate treatment to control the disease and prevent further progression and structural changes in the spine and SIJs. We recommend that all rheumatologists proactively and regularly audit their radiology department to improve the awareness and hence implement the correct protocol for MRI imaging in AxSpA. <h3>References</h3> [1]Rudalwaleit M, van der Heijde D,<i>et al</i>. Defining active sacroiliitis on MRI for classification of axial spondylarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann Rheum Dis 2009;68: 1520-7 [2]Maksymowych WP. The role of imaging in the diagnosis and management of axial spondylarthritis. Nat Rev Rheumatol 2019; 15: 657-72 [3]Derakhshan MH, Pathak H, Cook D <i>et al</i>. Services for spondylarthrits: A survey of patients and rheumatologists. Rheumatology(Oxford) 2018;57: 987-96 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.